纤维鼻咽镜下经环甲膜声带肉毒毒素注射治疗喉痉挛性构音障碍的应用效果

Fiberoptic nasopharyngoscopy-guided cricothyroid membrane puncture and botulinum toxin injection into the vocal cords in the treatment of spasmodic dysphonia

摘要:

目的 探讨纤维鼻咽镜下经环甲膜声带肉毒毒素注射治疗喉痉挛性构音障碍（SD）的临床疗效。方法 回顾性分析2022年12月－2024年12月于该院收治的17例SD患者的临床资料，观察患者A型肉毒毒素注射情况和并发症发生情况。结果 纤维鼻咽镜进入鼻腔时，2例（11.8%）患者发现一侧鼻腔严重狭窄，改由对侧鼻腔后顺利插入。在纤维鼻咽镜引导下，注射针经环甲膜穿刺进入喉腔，对双侧声带分别注射2 u的A型肉毒毒素。在注射过程中，3例（17.6%）患者出现严重呛咳，重复给予丁卡因表面麻醉后缓解；2例（11.8%）患者由于咳嗽和声带活动，出现注射针头脱落和药液部分滴漏，调整针头角度后，将剩余药液注入声带。整体操作时间0.43～0.68 h，平均0.58 h。注射后1～12 d，平均3.5 d，患者发音恢复正常，3例患者出现饮水呛咳，3例声嘶，3至4 d后缓解。结论 纤维鼻咽镜引导下经环甲膜声带肉毒毒素注射，操作方便，治疗SD的临床疗效好。值得临床推广应用。

Abstract:

Objective To explore the clinical efficacy of botulinum toxin injection through the cricothyroid membrane and vocal cords under fiberoptic nasopharyngoscopy in the treatment of spasmodic dysarthria (SD).Methods A retrospective analysis was conducted on the clinical data of 17 patients with SD from December 2022 to December 2024. Observe the type A botulinum toxin injection situation and the occurrence of complications in patients.Results When the fiberoptic nasopharyngoscopy was inserted into the nasal cavity, 2 cases (11.8%) found that one nasal cavity was severely narrowed. After switching to the opposite nasal cavity, the insertion was successful. Under the guidance of fiberoptic nasopharyngoscopy, the injection needle was punctured through the cricothyroid membrane into the laryngeal cavity, and 2 u of type A botulinum toxin was injected into both vocal cords respectively. During the injection process, 3 cases (17.6%) of patients experienced severe choking cough, which was relieved after repeated surface anesthesia with tetracaine. In 2 cases (11.8%), due to coughing and vocal cord activity, the injection needle fell off and part of the liquid medicine leaked. After adjusting the needle angle, the remaining liquid medicine was injected into the vocal cords. The overall operation time ranged from 0.43 ~ 0.68 h, with an average of 0.58 h. 1 ~ 12 d after injection, with an average of 3.5 d, the patients' pronunciation returned to normal. Three patients had choking cough when drinking water and three patients had hoarseness, which were relieved after 3 to 4 d.Conclusion Injection of botulinum toxin through cricothyroid membrane guided by fiberoptic nasopharyngoscopy is convenient and has a good clinical efficacy in the treatment of SD. It is worthy of clinical promotion and application.